Reduction In Burning Sensation Research Articles

Comparative Study on Efficacy of Topical Application of Triamcinolone Acetonide and Curcumin in Management of Oral Lichen Planus

Introduction: Oral lichen planus (OLP) is a chronic inflammatory and immune mediated disease that affects the mucous membranes. OLP is cell-mediated, immune damage to basal keratinocytes that are recognized as being antigenically foreign or altered. Many treatment modalities have been tried since the time immemorial, steroids being the mainstay of the treatment, with more benefits than adversities, but now-a-days alternative/ herbal medicines are used keeping in view the chronicity of disease and long term treatment required to cure it. Curcuminoids, the major constituent of turmeric, has anti-inflammatory, antioxidant and anticancer properties. Natural / herbal product has minimal adversities so this can be more helpful for patients in the upcoming time. Aim: The study was conducted to compare the efficacy of conventional topical corticosteroid, triamcinolone acetonide 0.1% with 1% curcumin gel in OLP patient and to assess reduction in burning sensation, regression of size and ulcero-erosive appearance of lesion. Materials and Methods: An intervention study was conducted on 40 patients diagnosed with OLP which were divided into two groups. Group A was provided with Ointment 0.1% triamcinolone acetonide while Group B was provided with 1% curcuma longa extracts gel for local application on the affected regions The results were analysed using Students t-test,discrete (categorical) data were summarised in number (n) and percentage (%) and compared by chi-square (χ2) test. Groups were also compared by two factor (groups and periods) repeated measure (RM) analysis of variance (ANOVA). Results: Intragroup comparison showed statistically significant reduction in burning sensation, size and extension of lesion (p<0.001) as well as erythema and ulceration (p<0.001) in both the groups. In inter-group comparison, Group A showed reduction in burning sensation (97.3%), size and extension of lesion (100%), reduction in erosive pattern (94.7%) and reduction in ulcerative .......

Vincristine, doxorubicin and cyclophosphamide chemotherapy induced oral chronic hyperplastic candidiasis and xerostomia in a young patient with Ewing’s sarcoma: A case report

Abstract A common primary bone malignancy in childhood and adolescence is Ewing’s sarcoma. Here we report multidisciplinary approach in the management of chronic hyperplastic candidiasis and xerostomia secondary to chemotherapy with vincristine, doxorubicin and cyclophosphamide (VDC) in a pediatric male patient with Ewing’s sarcoma of Ethmoid sinus. The initial diagnosed oral lesion was treated with topical clotrimazole 1%w/v for two weeks and Sucralfate 1g/10mL oral rinse for one month. Upon subsequent VDC chemotherapy cycle, the patient developed grade IV oral mucositis, severe neutropenia and associated oesophageal candidiasis. Treatment included combination of topical clotrimazole 1%w/v and Fluconazole 300mg/day (IV for 5 days and Tablet for 14 days). To prevent caries risk, pit and fissure sealants were applied and topical fluoride therapy was given; patient was encouraged to have frequent sips of water and prescribed kids xylitol gum for 15 days to minimize xerostomia. At 5-week follow up, reduction in burning sensation and resolution of white lesion was noted.

Comparative Evaluation of Pimecrolimus Cream 1% and Triamcinolone Aceonide Paste in Treatment of Atrophic-Erosive Oral Lichen Planus.

This study was done to assess the effects of pimecrolimus cream 1% and triamcinolone aceonide paste in the treatment of atrophic-erosive oral lichen planus. A total of 100 patients diagnosed both clinically and histopathologically as lichen planus were considered in the present study. Subjects were classified into two groups. Group I: Patients in this group were treated with 1% pimecrolimus cream and Group II: Patients falling under this group were treated with triamcinolone acetonide in 0.1% concentration. None of the patients reported worsening clinical signs and symptoms. No significant difference in efficacy and reduction in burning sensation of either pimecrolimus or trimcinolone acetonide was present. Present study found no significant difference in the efficacy of both the agents studied.

Efficacy of Punica Granatum (Pomegranate) in the Management of Oral Candidiasis – A Randomized Controlled Study

Background: Oral candidiasis is an opportunistic fungal infection of the mucus membrane, where Candida albicans (C. albicans) is commonly responsible for the infection, especially in immune-compromised patients. Resistance of Candida species to antifungal drugs has led clinicians to pay more attention to alternative therapy. Punicalagin, isolated from pomegranate peel, was reported to be effective against C. albicans. This study compares the efficacy of Punica granatum peel extract gel 0.2% with topical clotrimazole in oral candidiasis. Materials and Methods: Forty-four oral candidiasis patients aged 20–67 years of either sex were enrolled. The swab samples from the oral lesion were collected for periodic acid Schiff (PAS) staining, and a quantitative analysis of Candida species was carried out. They were randomly divided into two groups. Group I subjects were administered a topical application of P. granatum gel 0.2%. Group II subjects were administered clotrimazole 1%. Both medicaments were administered in the form of a topical gel thrice a day for 14 days. Follow-up was done on the 7th and 14th days. Results: Reduction in burning sensation measured with the mean visual analog scale (VAS) score was from 2.0238 to 1.3095 in group I and from 1.4783 to 0.8913 in group II. Reduction in the lesion size from baseline to post-treatment was from 1.652 to 0.781 in group I and from 0.939 to 0.439 in group II. Also, a reduction in candidal colony count from baseline to post-treatment was observed in both groups. The taste and tolerability of punicalagin were acceptable. Conclusion: P. granatum 0.2% is safe, well tolerated, and effective for oral candidiasis.

A comparative study to evaluate the efficacy of clobetasol and curcumin in patients with oral submucous fibrosis

Background: Oral submucous fibrosis (OSMF) was considered primarily as a disease prevalent in Southern Asia and southern Asian immigrants. However, it has been associated with an increased risk of malignant transformation and beginning to garner considerable attention world-wide. The main aim in management of OSMF is to relieve burning sensation and improve mouth opening. Aim and Objective: This study aimed to compare efficacy of curcumin (2 g) and topical clobetasol propionate (0.05%) cream in management of OSMF. Materials and Methods: This prospective and randomized study was conducted among sixty clinically diagnosed patients between age group of 18 and 50 years of age. They were randomly divided into two groups. Group A patients were instructed to apply topical clobetasol propionate cream (0.05%) thrice daily for 6 weeks. Group B patients were prescribed oral curcumin lozenges for 6 weeks. Recalls were done every week for up to 6 weeks for both groups for which burning sensation and mouth opening parameters were recorded. Results: The prevalence of OSMF was more in the younger age group which was due to increase in the chewing habit. Reduction in burning sensation was seen among patients in both groups but a significant reduction of 6.67 was seen with clobetasol group when compared with curcumin group with mean reduction of 2.53. Marked improvement in mouth opening was seen with Clobetasol ointment group when compared to curcumin group with a mean increase in mouth opening of 3.57 mm in the former and only 0.47 mm improvement in the latter. Conclusion: In the present study, both treatments were beneficial in reducing burning sensation significantly with clobetasol group showing better improvement as compared to curcumin group. There was a significant improvement in mouth opening with clobetasol group and nonsignificant results were obtained with curcumin group. Therefore, clobetasol can be opted as a drug of choice in improving mouth opening in OSMF patients.

Efficacy of hyaluronidase and dexamethasone intralesional injections in the management of oral submucous fibrosis

Objective: To evaluate the efficacy of intralesional injections of dexamethasone and hyaluronidase in the treatment of oral submucous fibrosis (OSMF).Materials and Methods: The present study included 180 patients with OSMF who were divided into four groups and 45 healthy individuals who were included in the control group. The OSMF subjects were injected with hyaluronidase 1,500 IU mixed in 1.5 ml of dexamethasone and 0.5 ml of lignocaine HCL intralesionally twice a week for one month along with a basic physiotherapy regimen consisting of mouth exercises two times daily. Individuals in the control group were administered placebo capsules. Treatment was carried out for 4 weeks, the burning sensation and mouth opening were evaluated before and after treatment.Results: A significant improvement in the mouth opening and reduction in burning sensation was noted in mild to moderate cases of OSMF after treatment.Conclusion: In this study, intralesional injection of hyaluronidase with dexamethasone is showed to be an effective method to manage the signs and symptoms in mild to moderate cases of OSMF

Effectiveness of a Mouth-Exercising Device in Adjunct to Topical Steroid and Antioxidants in OSMF—A Clinical Study

Objective: To evaluate the effectiveness of a mouth-exercising device (MED) on mucosal burning sensation and interincisal distance in adjunct to topical steroids and antioxidants in oral submucous fibrosis (OSMF) patients. Material and Methods: The study consisted of a total sample size of 60 subjects diagnosed with OSMF with no other systemic diseases. Group I includes 30 patients on topical application of triamcinolone 0.1% and oral antioxidant capsule along with receiving MED. Group II includes 30 patients on topical application of triamcinolone 0.1% and oral antioxidant capsule without receiving MED. Evaluation for mucosal burning sensation (BS) and interincisal distance (IID) was determined by VAS & digital Vernier caliper. Results: Group I patients using MED showed a statistically significant reduction in burning sensation and increasing interincisal distance compared to group II after six months. Conclusion: The MED helps enhance the rate of reduction of mucosal burning sensation and it is effective in increasing interincisal distance compared to the non-mouth-exercising device in OSMF.

Topical Herbal Therapeutic Formulation used in the Management of Oral Potentially Malignant Disorders – A Systematic Review

Background: Oral potentially malignant disorders (OPMDs) are divided into two groups precancerous lesions, a benign lesion with morphologically altered tissue, which has a greater than normal risk of transforming into malignancy, and precancerous conditions, a disease or patient's habit that does not necessarily alter the appearance of local tissues but is associated with a greater or normal risk of precancerous lesion or cancer development in that tissue. Aim: This systematic review aims to evaluate the effectiveness of topical herbal therapeutics in the management of potentially malignant oral disorders. Objective: Primary objective was to evaluate the efficiency of tulsi, aloe vera, and turmeric in the management of OPMDs, and the secondary objective was to determine the herbal therapeutic response in patients with oral leukoplakia oral sub, mucous fibrosis, and lichen planus. Data Sources and Search Methods: The search was done using the MeSH [medical subject headings] terms and keyword search in the electronic databases, namely Pub Med and Google Scholar. The studies included in this systematic review were identified by a comprehensive search from the electronic search engines like Pub Med Advanced search (from April up to January 2021) and Google scholar. The search yielded 39 articles out of which 11 articles were only included based on the inclusion criteria. Data Collection and Analysis: All the studies included were based on the data extraction and analysis of the studies for quality. The outcome measure evaluated the reduction in burning sensation, mouth opening, and clinical resolution of the lesion. Results: A total of 39 articles were included in this systematic review from electronic searches using Pub Med advanced search and Google scholar. Conclusion: For management of oral submucous fibrosis topical aloe vera gel showed 90% of complete clinical response, oral lichen planus topical tulsi and turmeric gel showed 90% complete clinical response, and only two studies were conducted on oral leukoplakia which had a high risk of bias; hence, this systematic review does not yield to a piece of conclusive evidence for the management of oral leukoplakia using topical herbal therapeutics.

Comparing the efficacy of intralesional triamcinolone acetonide and hyaluronidase with placental extract in oral submucous fibrosis cases: An original research

Intralesional infiltrations with placental extract and triamcinolone with hyaluronidase are equally effective in treating trismus of OSMF. No difference in treatment efficacy was seen in placental extract group or with triamcinolone with hyaluronidase group. Oral submucous fibrosis is a widely prevalent oral mucosal lesion in Indian population and considering its premalignant potential and severe clinical manifestations many studies are done by many authors regarding various aspects of this condition such as etiology pathogenesis and treatment. Arecoline of Areca catechu is mostly attributed as the causative factors in addition to pan and tobacco in different combinations. In our study a random allocation of 120 patients was done equally into two groups. Group 1 received 4 ml of placental extract injection intralesionally at weekly interval for 12 weeks and Group 2 received combination of triamcinolone acetonide( 10 mg/ml) + hyaluronidase (1,500 IU) at weekly intervals for 12 weeks. Treatment outcome was evaluated on the basis of improvement in trismus, oral mucosal pattern and reduction in burning sensation.

ANTIHYPERTENSIVES IN ORAL SUB MUCOSAL FIBROSIS

Oral submucous brosis is a common pre-malignant condition affecting the oral mucosa with more prevalence among Indian population. Various treatment modalities have been elucidated in order to alleviate the symptoms associated with OSMF. Currently oral Anti hypertensive has been proved to have benecial result in treating OSMF because of its anti-inammatory, brinolytic, immunomodulatory and rheologic modifying property. Several categories of drugs have been used in the treatment of OSMF but their effectiveness leaves much to be desired and no treatment regimen has afforded denitive cure. While Oral administration limits the concentration of drugs in lesional tissue and increases the potential for side effects, the Intralesional injections are associated with signicant mechanical injury and non compliance on the patient’s part because of the accompanying discomfort and pain. The present study was done to evaluate the effectiveness of oral antihypertensives in the management of OSMF Very few studies across world have showed that anti hypertensive drugs showed signicant improvement in mouth opening, reduction in burning sensation. Hence anti hypertensive can be a good alternative in the management of OSMF for whom intralesional steroids or hyaluronidase are contraindicated, for those who cannot make frequent visit and to avoid pain due to injection. And most importantly anti hypertensive is cost effective and more compliant to the patient.

Antihypertensives in oral submucous fibrosis

Oral submucous fibrosis is a common pre-malignant condition affecting the oral mucosa with more prevalence among Indian population. Various treatment modalities have been elucidated in order to alleviate the symptoms associated with OSMF. Currently oral Anti-hypertensive has been proved to have beneficial result in treating OSMF because of its anti-inflammatory, fibrinolytic, immunomodulatory and rheologic modifying property. Several categories of drugs have been used in the treatment of OSMF but their effectiveness leaves much to be desired and no treatment regimen has afforded definitive cure. While Oral administration limits the concentration of drugs in lesional tissue and increases the potential for side effects, the Intralesional injections are associated with significant mechanical injury and noncompliance on the patient’s part because of the accompanying discomfort and pain. The present study was done to evaluate the effectiveness of oral antihypertensives in the management of OSMF. Very few studies across world have showed that anti-hypertensive drugs showed significant improvement in mouth opening, reduction in burning sensation. Hence anti-hypertensive can be a good alternative in the management of OSMF for whom intralesional steroids or hyaluronidase are contraindicated, for those who cannot make frequent visit and to avoid pain due to injection.

English

BACKGROUND Medicinal plants and their extracts have been found to possess potent antiinflammatory, antioxidant and anti-cancer properties that slow down the cellular proliferation and malignant transformation rate of orally potential malignant disorders such as oral leukoplakia, oral submucous fibrosis and oral lichen planus. They are a potential source of antioxidants such as vitamin A, E, and C that neutralize the free radicals produced in various oral mucosal lesions thereby preventing the mucosal damage. They have been found to modulate cellular signalling pathways and, this activation influences the cellular defence mechanisms that protect the normal cells against reactive oxygen species or reactive metabolites and induces apoptotic death of cancerous cells, thus chemoprevention ensues to prevent, reverse or delay carcinogenesis. They have been studied to enhance tumour cell killing and inhibition of metastasis by increasing number of immunocompetent cells such as macrophages, cytotoxic T lymphocytes, natural killer cells and by recruitment of antibodies at the tumour site. Now a days, natural herbs or phytochemicals are gaining attention due to side effects and increased antimicrobial resistance that often occur with prolonged use of chemotherapeutic agents. Therapeutic effect of phytochemicals in oral PMDs is very promising as they prevent the progression of dysplasia from mild to severe. Literature has revealed significant reduction in burning sensation, difficulty in swallowing and speech, and pain associated with the oral mucosal lesion. However, more research should be conducted in future to establish their use as an adjunctive therapy in oral potentially malignant disorders. By this review, an attempt has been made to highlight therapeutic potential of diverse herbs such as aloe vera, tulsi, neem, curcumin, lycopene, green and black tea, peppermint etc. in the reduction of clinical symptoms of burning sensation and pain associated with the oral mucosal lesions, and discusses their indispensable role in prevention of oral cancer. KEY WORDS Antioxidants, Chemoprevention, Phytochemicals, Oral Cancer

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).
 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.
 Results: Both curcumin group and intralesional injection group showed reduction in burning sensation with p<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.
 Conclusion: Curcumin capsule is effective, safe and alternative treatment modality in OSMF.

Erosive oral lichen planus

Plethora of clinical forms exists in oral lichen planus (OLP), a common autoimmune disease involving mucous membrane. The commonest forms described in the literature are reticular, atropic, papular, bullous, plaque and erosive. The erosive type being the second most common, is a premalignant condition owing to its aggressiveness. A 54-year-old male presented to private clinic with one year history of intermittent burning sensation on inner aspect of cheeks. He was on antihypertensives since two years and using tobacco for the past ten years. On oral examination, the lesion was extending from commissure of lip to retromolar region bilaterally, with elevated white lacy streaks/striae (Wickam´s striae) throughout the lesion, typical of lichen planus (LP). On palpation, tenderness (+) and lesion was unscrapable. The case was provisionally diagnosed as erosive LP. Incisional biopsy was taken and histopathological examination confirmed the provisional diagnosis. Patient was treated with antioxidants, topical and systemic steroids. After one week, patient had a note-worthy reduction in burning sensation. Patient was encouraged to quit tobacco, educated about oral cleanliness and was encouraged to seek regular follow-up to monitor the disease. The odds of oral lichen planus developing into squamous cell carcinoma go upto 10, among which erosive type has a noteworthy frequency. Hence, it is prudent for all clinicians to do oral examination for each and every patient for it provides a clue to diagnose a wide gamut of diseases. Early identification of oral lesions will help in effective treatment as well as to avert grievous complications like malignant transformation.

Comparative Evaluation of Novel Gel-Containing Curcumin, Aloe Vera, and Honey with Triamcinolone Acetonide as an Adjunct to Oral Physiotherapy in Oral Submucous Fibrosis Patients

Background and Objective: Oral submucous fibrosis (OSMF) is a juxtraepithelial inflammatory reaction followed by fibro elastic change of lamina propria. Hence, the inflammation is a definite component of OSMF. Combinations of turmeric, Aloe vera, and honey have antioxidant and anti-inflammatory effects which may act synergistically to serve as beneficiary for treating OSMF disease. Hence, the present study aims to compare the efficacy of topical application of novel gel containing curcumin, Aloe vera, honey, and physiotherapy with 0.1% triamcinolone acetonide and physiotherapy in the reduction of clinical signs and symptoms of OSMF patients. Materials and Methods: A total of 20 clinically diagnosed OSMF patients were divided into two groups containing 10 patients each. Participants including in Group A were treated with topical application of novel gel-containing curcumin, Aloe vera, and honey along with physiotherapy. Group B patients were treated with the topical application of 0.1% triamcinolone acetonide along with physiotherapy. Participants were evaluated at baseline and at the 7th day, 14th day, and 21st day. They were evaluated for mouth opening (maximum interincisal distance) and burning sensation (Visual Analogue Scale). Results: The reduction in burning sensation and increase in mouth opening is observed in both the groups. Both groups showed no statistically significant difference. Thus, both are statistically equally effective. Reduction burning sensation at the 21st day was more in Group A than in Group B, but difference is not statistically significant. Conclusion: Novel gel is as effective as topical steroid triamcinolone acetonide in reducing the signs and symptoms of OSMF.

COMPARE TO INTRALESIONAL THERAPY AND PHYTOCHEMICAL BASED SYSTEMIC DRUG THERAPY IN ORAL SUBMUCOUS FIBROSIS-CLINICOPHAMACOLOGICAL STUDY

Introduction: Oral sub-mucous fibrosis (OSMF) is characterized by abnormal collagen deposition. It is a precancerous disorder and transforms into a malignant tumor in 1.5–15% of all cases. Symptoms include submucous fibrosis, ulceration, xerostomia, a burning sensation restricted mouth opening and restricted tongue protrusion followed by oral mucosal blanching and uvla deviation. All of these greatly interfere with patient quality of life. Curcuma longa has been used for thousands of years as a remedy in the traditional Indian and folk medicine for the cure of a large variety of illnesses, such as inflammation, infectious diseases, and gastric, hepatic, and blood disorders. Curcumin is a major isolated polyphenol from the rhizome of turmeric (Curcuma longa). It has a wide range of pharmacological effects such as antioxidant, anti-inflammatory, antimicrobial, antitumor, and hepatoprotective activities. In our study curcumin used in OSMF as a systemic drug therapy and compare with intra-lesional therapy that’s widely used in OSMF Aims and objective: To check the efficacy of systemic drug therapy (curcumin longa) in OSMF, and compare with intra-lesional therapy (Dexamethasone with Hyaluronidase) in OSMF. Material and method 100 patients with clinically proven Oral Submucous Fibrosis were selected for the study and were randomly divided into 2 groups. The first group was treated with weekly Intralesional injection of 4 mg Dexamethasone & 1500 I.U Hyaluronidase and the second group by oral administration of two Curcumin tablets (Turmix 300 mg) per day for 4 months each. Improvement of burning sensation, interincisal distance, tongue protrusion and ulceration was evaluated on a weekly basis and compare to initial visit to end of treatment duration. Statistical analysis and Results: Burning sensation improved in both the groups from early to late stages. Complete Resolution of burning sensation was noted with Turmix early compare to intra-lesional therapy. The mean increase in inter-incisal distance or mouth opening was more compare to systemic drug therapy. The inter-incisal distance improved in both the groups gradually, but not more significant results at systemic drug therapy the end of both therapies. Tongue protrusion showed greater recovery at the end of last stmonth in group 1 when compared with group 2. Conclusion: Turmix is beneficial and effective in reducing burning sensation in early OSMF Patients so we can concluded on the basis of symptomatic relief systemic drug therapy with phyto-chemical based drug given better results compare to intralesional therapy.

A clinicobiochemical evaluation of curcumin as gel and as buccal mucoadhesive patches in the management of oral submucous fibrosis

The objective of this study was to evaluate and compare the efficacy of topical curcumin gel and buccal mucoadhesive patches in the management of oral submucous fibrosis (OSMF). Forty patients clinically diagnosed with OSMF were randomly divided into 2 groups. Group A received curcumin gel and group B received curcumin mucoadhesive patches, to be used twice daily for 8 weeks. Evaluation was done every 2 weeks. Serum lactate dehydrogenase (LDH) levels were measured before and after treatment and also in 20 healthy controls. A 100% reduction in burning sensation was observed in all 40 patients at the end of 4 weeks. Mouth opening improved by 5.45 ± 1.64 mm in group A and 5.9 ± 2.00 mm in group B. Pretreatment LDH was 359.72 ± 77.02 IU/L in patients with OSMF, which was significantly higher than that in healthy volunteers (173.2 ± 46.20 IU/L). In group A, LDH values reduced from 341.85 ± 71 IU/L to 264.95 ± 65.09 IU/L and in group B, values reduced from 377.6 ± 79.76 IU/L to 286.15 ± 72.95 IU/L after treatment. Curcumin gel and mucoadhesive patches were effective in improving mouth opening and reducing burning sensation in patients with OSMF. They can therefore be considered as safe, noninvasive modalities for treatment of OSMF.

Efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and QOL in patients with OSF

ObjectivesTo assess the efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and quality of life (QOL) in patients with oral submucous fibrosis. Study designSixty patients were divided in 4 groups; group A received 8 mg of betamethasone, group B received 3000 IU of hyaluronidase, group C received the combination of betamethasone and hyaluronidase and group D received saline injections biweekly for 5 weeks. Patients were also assessed using QOL questionnaire. ResultsMouth opening and oral burning of the four groups for final visit, using the pretreatment opening as a covariate showed significant difference for group A, B, C. ConclusionBetamethasone and hyaluronidase injections appears to be a viable option to increase mouth opening with reduction in burning sensation

Comparative study of intralesional injection of triamcinolone versus placental extract in cases of oral submucous fibrosis

<p class="abstract"><strong>Background:</strong> Oral submucous fibrosis (OSMF) is a common premalignant condition caused by chewing arecanut, betel quid and gutkha with tobacco. One of the important therapeutic modalities is intralesional injection therapy. The most commonly used intralesional agents are placental extract, corticosteroids and hyaluronidase.</p><p class="abstract"><strong>Methods:</strong> Patients of OSMF (30) were randomly allocated and 15 patients were given 1 ml placental extract submucosally in each retromolar trigon weekly for 8 weeks and 15 patients were injected with 40 mg/ml of triamcinolone submucosally on each side weekly for 8 weeks. The mouth opening was measured as the inter-incisor distance by Vernier calliper at maximal active mouth opening by patient at initial visit and every follow up visit and recorded. Treatment outcome was evaluated on the basis of improvement in trismus, oral mucosal pattern and reduction in burning sensation. </p><p class="abstract"><strong>Results:</strong> Out of 30 patients, 27 were males and 3 females. 16 patients (53.33%) were in the age group of 21-30 years. Most of patients in our study had complain of reduced mouth opening and inability to take spicy food which is 93.33% of cases followed by burning sensation in mouth 90%, oral ulceration 83.33%, dryness of mouth 30%, difficulty/pain in swallowing 13.33% and halitosis 2%. 60% of patients mouth opening was improved >10 mm with triamcinolone while in placental extract 26.6%. Symptomatic relief were obtained more with injection placental extract.</p><p class="abstract"><strong>Conclusions:</strong> Triamcinolone injection has more improvement in mouth opening compared to placental extract. It was observed that injection placental extract gives good symptomatic relief in the major symptoms like burning sensation in mouth, inability to take spicy food, oral ulceration compared to injection triamcinolone.</p>

Oral submucous fibrosis: a study of qualitative and analytical treatment using intralesional injections: placental extract versus combination of steroid with hyaluronidase

<p class="abstract"><strong>Background:</strong> One of the premalignant conditions in oropharynx is oral submucous fibrosis (OSMF). It is a chronic debilitating condition of unknown etiology leading to fibrosis of mucosa affecting the oropharynx, esophagus and thus causes decreased mouth opening and dysphagia respectively. The disease is of multifactorial etiology with addictions, nutritional, micro elements and antioxidants deficiencies. In India males are more affected than females, due to their stress related excessive, irresponsible chewing habits. The available management is for symptomatic relief and at present there is no definitive treatment is available.</p><p class="abstract"><strong>Methods:</strong> We have studied 60 cases diagnosed with OSMF with mild to moderate restricted mouth opening. Most of patients were between 17 to 55 years of age selected by randomized clinical trial. Its management was divided into 2 groups where group A was treated with a combined intralesional regimen of injection triamcinolone 40mg and hyaluronidase 1500 IU, while group B was treated with injection of 2ml placental extract. Each group has given a single dose intralesional injection per week for six weeks. </p><p class="abstract"><strong>Results:</strong> It was a comparative study of improvement in effectiveness on mouth opening and reduction in burning sensation of oral cavity seen in group A regimen than group B. Those having persistent trismus, needed surgery.</p><p class="abstract"><strong>Conclusions:</strong> No effective treatment available but along with intralesional injection can give symptomatic relief. In addition, cessation of habits, antioxidants oral hygiene helps in improvement of OSMF.</p>