Treatment Of Oral Submucous Fibrosis Research Articles

Efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis: A meta-analysis of randomized controlled trials.

Background:This study was performed to systematically review the efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis.Methods:We searched 9 databases: Web of Science, PubMed, Medline, EBSCO, Embase, The Cochrane Library, WanFang Data, the China National Knowledge Infrastructure (CNKI), and Chinese Scientific Journals Full-text Database (VIP). Randomized controlled trials were collected to study the treatment of oral submucous fibrosis by S miltiorrhiza injection combined with steroids. Each database was searched from inception to November 2018. RevMan 5.3 software was used for the meta-analysis.Results:In total, 13 randomized controlled trials involving 1190 patients were included. The results of the meta-analysis showed that compared with conventional treatment, S miltiorrhiza injection combined with steroids could significantly increase the maximal mouth opening [mean difference (MD), 0.23; 95% confidence interval (CI), 0.16–0.30; P <.0001], decrease the oral mucosal lesion area (MD, −1.35; 95% CI, −2.46 to −0.25; P = .02), improve the subjective symptom burning sensation (MD, −0.77; 95% CI, −1.38 to −0.16; P = .01), and reduce adverse drug reactions (risk ratio, 0.27; 95% CI, 0.14–0.49; P <.0001).Conclusions:The results of this meta-analysis from current evidence showed that compared with conventional treatment, S miltiorrhiza injection combined with steroid could significantly improve the maximal mouth opening and the subjective symptom burning sensation as well as decrease the oral mucosal lesion area without increasing adverse effects.

Comparison of Efficacy of Lycopene and Lycopene-Hyaluronidase Combination in the Treatment of Oral Submucous Fibrosis.

Background:Oral submucous fibrosis (OSMF) is a chronic progressively scarring disease of the oral cavity. Lycopene is a powerful antioxidant obtained from tomatoes and has the highest singlet oxygen quenching capacity and a high capacity of quenching other free radicals in vitro among dietary carotenoids. Hyaluronidase is a substance prepared from the testes and semen of mammals that modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid.Objective:To evaluate the efficacy of lycopene and lycopene−hyaluronidase combination, and to compare the efficacy of lycopene and lycopene−hyaluronidase combination in the treatment of OSMF.Study Design:The study consisted of 45 patients with OSMF divided into three equal groups. Patients in Group A were given Lycored 16 mg daily in two equally divided doses for 3 months. Patients in Group B were given LycoRed along with hyaluronidase intralesional injection of 1500 IU twice weekly for 3 months. Patients in Group C were given placebo capsules. Patients were evaluated after 3 months. The following parameters were recorded: mouth opening, visual inspection, palpatory findings, and burning sensation.Results:There was statistically significant change in mouth opening and burning sensation for lycopene and lycopene–hyaluronidase combination than in the placebo group in the treatment of OSMF, but the lycopene–hyaluronidase combination did not show any statistically significant change when compared with lycopene alone.Conclusion:Lycopene appears to be a very promising antioxidant in the management of oral submucous fibrosis, both in clinical and symptomatic improvement.

A randomised double blinded trial to evaluate the efficacy off curcumin in natural turmeric matrix in the treatment of oral submucous fibrosis - A study of 50 cases

A randomised double blinded trial to evaluate the efficacy off curcumin in natural turmeric matrix in the treatment of oral submucous fibrosis - A study of 50 cases

Biostimulation with diode lasers: A novel futuristic approach in the treatment of oral submucous fibrosis – A case report

Biostimulation with diode lasers: A novel futuristic approach in the treatment of oral submucous fibrosis – A case report

Hinokitiol ablates myofibroblast activation in precancerous oral submucous fibrosis by targeting Snail.

Oral submucous fibrosis (OSF) is a precancerous condition with symptoms of limited mouth opening and areca nut chewing habit has been implicated in its pathogenesis. Hinokitiol, a natural tropolone derived from Chamacyparis taiwanensis, has been reported to improve oral lichen planus and inhibit various cancer cells. Here, we showed that hinokitiol reduced the myofibroblast activities in fBMFs and prevented the arecoline-induced transdifferentiation. Treatment of hinokitiol dose-dependently downregulated the myofibroblast markers as well as various EMT transcriptional factors. In particular, we identified that Snail was able to bind to the E-box in the α-SMA promoter. Our data suggested that exposure of fBMFs to hinokitiol mitigated the hallmarks of myofibroblasts, while overexpression of Snail eliminated the effect of hinokitiol. These findings revealed that the inhibitory effect of hinokitiol on myofibroblasts was mediated by repression of α-SMA via regulation of Snail and showed the anti-fibrotic potential of hinokitiol in the treatment of OSF.

Comparative Study of the Efficacy of Newer Antioxitands Lycopene and Oxitard in the Treatment of Oral Submucous Fibrosis

Objective: To compare the efficacy of oxitard and lycopene in the management of Oral Submucous Fibrosis (OSMF). Material and Methods: 120 subjects with clinic-pathologically diagnosed OSMF were included in the study and divided equally in 2 groups, Group A (oxitard) and Group B (lycopene). Group A was administered 2 oxitard capsules twice daily and Group B was given 8 mg lycopene in 2 divided doses of 4 mg for 3 months. Gingival index and plaque index were documented for all patients and compared. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Student’s paired t test and Chi-square test. P-value 0.001) among the 2 groups. Although the mean gingival index and plaque index in group A was reduced but it was found to be not statistically significant. Conclusion: Oxitard capsules can bring about significant clinical improvements in the symptoms like mouth opening, tongue protrusion, difficulty in swallowing and speech and pain associated with the lesion when compared to lycopene, thereby improving the quality of life of the affected individuals.

Haemorheological effect of pentoxifyllin for the treatment of Oral Submucous Fibrosis: a review

Haemorheological effect of pentoxifyllin for the treatment of Oral Submucous Fibrosis: a review

Assessment of utility of Tulsi and Turmeric in treatment of oral submucous fibrosis: A clinical study

Assessment of utility of Tulsi and Turmeric in treatment of oral submucous fibrosis: A clinical study

Evaluation of the role of a mouth rinse containing turmeric, triphala, and honey in the treatment of oral submucous fibrosis: An open label clinical study

Background: Oral submucous fibrosis (OSMF) is a chronic disease affecting any part of oral mucosa. A proper cure of this disease is of utmost requirement. Our aim of this study is to explore the effectiveness of a novel herbal mouth rinse containing curcumin, triphala and honey in the treatment of OSMF. Methods: Subjects were included in this study from the outpatient department of Dr. R Ahmed Dental College and Hospital. Clinical assessments of the oral condition were done at subsequent follow up visits (at entry, end of 30 days and end of 60 days). Results: Out of 12 females and 28 males included in the study, all showed significant reduction in regards to difficulty in mouth opening, blanched mucosa, pain at rest and lesion size. Results were analyzed using ANOVA Friedman test followed by Dunn's multiple comparisons test to observe the statistical significance. Conclusion: Efficacy and safety of mouth rinse containing curcumin, triphala and honey in relieving symptoms associated with OSMF was established in this study.

Utility of superiorly based platysma myocutaneous flap for reconstruction of intraoral surgical defects: our experience.

Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes. In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under T1N0M0 category only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used. In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44years. Intraoperative mouth opening was achieved up to 48mm in OSMF followed by 42.5mm postoperatively after 2years. However, uneventful healing and acceptable scar on cervical region was noted in all the cases including OSCC. In OSMF, three cases of dehiscence, four partial necrosis at end of flap and in OSCC one case shows skin loss at flap and two partial necrosis at tip of flap and extraoral localised abscess at ipsilateral donor site in one case was noted. An uneventful healing, anatomical form and functional results were restored with acceptable scarring at donor site without any evidence of difficulty in neck movements were observed. The PMF is simple, versatile and could be valued as a reconstructive alternative, with interesting visual qualities. It is a good therapeutic alternative tool for reconstruction of the buccal mucosa, especially for small- and medium-sized defects between 2 and 4cm2 of the oral cavity.

Physiotherapy in Treatment of Oral Submucous Fibrosis Related Restricted Mouth Opening

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

Role of Laser Biostimulation in Treatment of Oral Submucous Fibrosis: A Clinical Trial

AIM: To evaluate the efficacy of Low Level Laser Therapy (LLLT) in treatment of Oral Submucous Fibrosis (OSMF).MATERIAL &amp; METHODS: 20 patients with a clinical diagnosis of OSMF were included in the study after informed consents and measurements of mouth opening (mm) and burning sensation (VAS) were made at day 0. Laser biostimulation was performed on right and left cheeks in anterior and posterior bands for 3 cycles of 10 seconds each. They were recalled for follow-up measurements and Laser biostimulation at 3rd, 7th and 15th day. The paired t-test was applied for analysing significant differences, if any, using SPSS version 21.0.RESULTS: In the follow up recordings, generally, there was an increase in mouth opening after LLLT therapy and a significant difference was seen in males(p=.04) as well as the total population(p=0.02). Burning sensation(VAS Scale), on day zero was 5.5±1.20, which was reduced to 3.4±.084 on the 15th day with a significant difference seen in the entire study population(p=0.03).CONCLUSION: Biostimulation by Laser in the treatment of OSMF is a good non-invasive, painless and quick alternative treatment modality for the management of diseases.

Evaluating the efficacy of pentoxifylline in the treatment of oral submucous fibrosis: A meta-analysis.

Oral submucous fibrosis (OSMF), a potentially malignant oral cavity disorder that causes speech and mastication problems, lacks an established treatment regimen; moreover, no treatment can effectively reverse the course of OSMF. A meta-analysis was conducted to investigate the efficacy of the peripheral vasodilator, pentoxifylline, in the treatment of OSMF. We searched five different databases for studies meeting our eligibility criteria (up to June 30, 2017). Statistical analyses were performed using RevMan 5.3 software. Three randomized controlled trials (247 OSMF patients) were selected. Pentoxifylline increased the objective sign maximal mouth opening (MMO; WMD: -4.59, 95% CI: -8.65, -0.53; p<0.05) following short-term (under 1month; WMD: -1.94, 95% CI: -3.12, -0.77; p<0.05) and long-term (over 1month; WMD: -5.44, 95% CI: -6.81, -4.07; p<0.05) application. Pentoxifylline improved the subjective symptom burning sensation (WMD: -0.11, 95% CI: -0.17, -0.05; p<0.05) only following long-term application (WMD: 0.42, 95% CI: 0.18, 0.96; p<0.05). The efficacy on MMO and burning sensation increased with time. Although OSMF lacks definitive treatment modalities, our meta-analysis shows that pentoxifylline effectively improves the objective signs and subjective symptoms of OSMF and its therapeutic efficacy increases with time.

Arecoline activates latent transforming growth factor β1 via mitochondrial reactive oxygen species in buccal fibroblasts: Suppression by epigallocatechin-3-gallate.

Oral submucous fibrosis (OSF) is a premalignant condition caused by the chewing of areca nut (AN). Transforming growth factor β (TGFβ) plays a central role in the pathogenesis of OSF. Connective tissue growth factor (CTGF or CCN2) and early growth response-1 (Egr-1) are important mediators in the fibrotic response to TGFβ in several fibrotic disorders including OSF. Arecoline, a major AN alkaloid, induced the synthesis of CCN2 and Egr-1 in human buccal mucosal fibroblast (BMFs). The aims of this study were to investigate whether arecoline-induced CCN2 and Egr-1 syntheses are mediated through TGFβ1 signaling and to inspect the detailed mechanisms involved. Western blot and TGFβ1 Emax® ImmunoAssay were used to measure the effect of arecoline on the TGFβ signaling pathways. 2',7'-dichlorodihydrofluorescein diacetate and MitoSOX™ Red were used to measure the effect of arecoline on the cellular and mitochondrial reactive oxygen species (ROS). Arecoline induced latent TGFβ1 activation, Smad2 phosphorylation, and mitochondrial and total cellular ROS in BMFs. TGFβ-neutralizing antibody completely inhibited the arecoline-induced synthesis of CCN2 and Egr-1. Mito-TEMPO, a mitochondria-targeted antioxidant, completely suppressed arecoline-induced latent TGFβ1 activation and mitochondrial and total cellular ROS. Epigallocatechin-3-gallate (EGCG) dose-dependently inhibited arecoline-induced TGFβ1 activation and mitochondrial ROS in BMFs. Our results indicated that arecoline-induced mitochondrial ROS plays pivotal roles in the activation of latent TGFβ1 leading to the initiation of TGFβ1 signaling and subsequent increase in the synthesis of CCN2 and Egr-1. EGCG can be a useful agent in the chemoprevention and treatment of OSF.

Refined autogenous fat grafting as a de novo treatment of oral submucous fibrosis

Refined autogenous fat grafting as a de novo treatment of oral submucous fibrosis

Response of lycopene in treatment of oral submucous fibrosis

Introduction: Oral Submucous Fibrosis (OSF) is a well-known precancerous condition with malignant transformation rate as high as 7.6%. It results in marked rigidity of oral cavity and an eventual inability to open the mouth. Although OSF has a high rate of morbidity but no reliable treatment modality for its management has been developed yet. Objective: To determine the frequency of positive response of oral lycopene in the treatment of patients with Oral Submucous Fibrosis. Methods:A descriptive case series of patients with OSF was conducted at our institution for a period of 6 months i.e.18-11-2014 to 18-05-2015 in the Department of Oral &amp; Maxillofacial Surgery, King Edward Medical University, Lahore. Data was collected by using non-probability sampling technique. After informed consent, all patients were prescribed lycopene 30 mg BD dose for a period of 6 months. Changes in mouth opening (IIO) was measured every month for each patient. Data was entered and analyzed using SPSS 20. Results: A total number of 100 cases were selected for this study. Mean age of the patients was 27.24±8.22 of which 53(53%) were male and 47(47%) were female cases. Positive response of lycopene was noted in 76(76%) of cases while 24(24%) did not respond to the treatment. No adverse effects reported during the treatment period as well as during follow-up. Conclusion: It is concluded that the lycopene can and should be used as a first line of treatment in the management of Oral Submucous fibrosis.

Clinical effectiveness of salvianolic acid B and triamcinolone acetonide in treatment of oral submucous fibrosis

Objective: To evaluate the clinical effectiveness of salvianolic acid B (SA-B) and triamcinolone acetonide (TA) by means of combined intralesional injection in the treatment of oral submucous fibrosis (OSF). Methods: According to clinical findings and symptoms, TA combined with SA-B were consecutively applied intralesionally 1 time weekly for 30 times. Mouth opening degree, color change of the buccal mucosae and numeral increase of the capillary vessels were determined by degree Ⅰ-Ⅳ visual analog scale were evaluated at 12, 24, and 36 months, respectively. Results: One hundred and fourteen subjects fulfilled the study without obvious adverse reactions. After treatment for 1 year, the net gain in mouth opening of the early stage group was (5.5 ± 1.5) mm at 12 months, (8.8 ± 1.6) mm at 24 months and (12.0±1.2) mm at 36 months. The net gain in mouth opening of the middle stage group were (5.3±1.7) mm at 12 months, (10.5±1.5) mm at 24 months and (14.5±2.4) mm at 36 months. The net gain in mouth opening of the advanced stage group were (5.7±1.3) mm at 12 months, (13.7±1.3) mm at 24 months and (15.5±1.5) mm at 36 months. The effective rates of color change of the buccal mucosae and numeral increase of the capillary vessels after treatment for 36 months were 100% in early stage group, 93% (51/55) in middle stage group and 90% (36/40) in advanced stage group. Conclusions: TA and SA-B combined intralesional injection in the treatment of oral submucous fibrosis is effective.

Evaluation of Oral Pentoxifylline in the Management of Oral Submucous Fibrosis - An Ultrasonographic Study.

Aim and Objective:To evaluate the therapeutic efficacy of oral pentoxifylline in the treatment of oral submucous fibrosis (OSMF) patients by assessing the clinical symptoms such as burning sensation, mouth opening, and submucosal layer thickness and echogenicity using ultrasonography, both pre- and post-operatively.Materials and MethodsThirty study subjects were included in the study and divided into two groups in single-blind randomized manner, oral pentoxifylline and dexamethasone group. Burning sensation, mouth opening, ultrasonographic submucosal thickness, and echogenicity were recorded both pre- and post-operatively. Any adverse effects reported by the patients were also noted. The data collected were statistically analyzed, and response to pentoxifylline and intralesional dexamethasone with hyaluronidase was observed using ultrasonography.ResultsA highly significant reduction (P < 0.001) in burning sensation, improvement in mouth opening, and changes in submucosal thickness were noticed in both groups, and significant improvement (P < 0.05) in echogenicity in both the groups was noticed. However, pentoxifylline group showed marginally better improvement than dexamethasone group.Conclusion:Pentoxifylline can bring about significant improvement in OSMF, which can be used as better alternative where intralesional steroid was contraindicated or not well tolerated.

Clinical Efficacy of a Mouth-Exercising Device Adjunct to Local Ointment Intra-Lesional Injections and Surgical Treatment for Oral Submucous Fibrosis: a Randomized Controlled Trial.

Oral physiotherapy or mouth exercise is considered to be an adjunct but mandatory treatment modality for oral submucous fibrosis (OSMF). This study planned to evaluate the clinical efficacy of a newly designed mouth exercising device (MED) in OSMF patients receiving local ointment, intra-lesional drugs and surgical treatment. A total of 231 OSMF patients were selected and treated with basic regime including topical corticosteroids, oral antioxidants and the icecream-stick exercise regime and allotted randomly to two equal groups A and B. Group-A patients were additionally given MED. Subgroups A1 and B1 patients with an inter-incisal distance (IID) 20-35mm were not given any additional therapy; subgroup A2 and B2 patients (IID 20-35mm) were treated additionally with intra-lesional injections. Subgroups A3 and B3 with IID<20mm were managed surgically. IID was measured at baseline and at 6 months recall. The change in IID measurements was calculated and statistically analyzed using 2-way ANOVA and Tukeys multiple post hoc analysis. Average improvement in IID after six months of recall visits was observed to be 8.4 mm in subgroup-A1 (n-53) compared to 5.5 mm in B1(n-50) (p<0.01). The IID improvement in subgroup-A2 was found to be 9.3mm (n-46) compared to 5.1 mm in B2 (n-48) (p<0.01). In the surgery group, mouth opening improvement was observed to be 9.6 mm in subgroup A3 (n-18) compared to 4.8 mm for B3 (n-16) (p<0.01). Use of the MED appears to be effective for increasing oral opening in OMSF patients in conjunction with local, injection and/or surgical treatment.

Epigallocatechin-3-gallate inhibits transforming-growth-factor-β1-induced collagen synthesis by suppressing early growth response-1 in human buccal mucosal fibroblasts

Transforming growth factor (TGF)-β is a key regulator in the pathogenesis of oral submucous fibrosis (OSF). Early growth response (Egr)-1 is essential for fibrotic responses to TGF-β. Because TGF-β signaling is cell-type- and context-dependent, we investigated the signaling involved in TGF-β-induced Egr-1 in primary human buccal mucosal fibroblasts (BMFs). TGF-β-induced Egr-1 and its signaling were assessed by western blotting in BMFs. Egr-1 small interfering RNA was used to define the role of Egr-1 on TGF-β-induced mRNAs of the α1- and α2-chains of type I collagen (COL1A1 and COL1A2) and acid-soluble collagen production (via Sircol collagen assay). The effects of epigallocatechin-3-gallate (EGCG) on TGF-β-induced Egr-1 protein and acid-soluble collagen were also evaluated. TGF-β1 stimulated Egr-1 production in BMFs. Pretreatment with PD98059, SP600125, SB431542, and SIS3, but not SB203580, significantly reduced TGF-β1-induced Egr-1 protein expression. Genetic targeting of Egr-1 completely inhibited TGF-β1-induced type I collagen mRNAs and collagen protein expression. EGCG fully inhibited TGF-β1-induced Egr-1 and TGF-β1-stimulated production of acid-soluble collagens. We conclude that activin receptor-like kinase (ALK)5, Smad3, extracellular signal-regulated kinase, and c-Jun N-terminal kinase are involved in the TGF-β1-induced Egr-1 protein production in BMFs. Egr-1 mediates TGF-β1-induced COL1A1 and COL1A2 mRNA expression and acid-soluble collagen production in BMFs. EGCG can block TGF-β1-induced collagen production by attenuating Egr-1 expression in BMFs. Egr-1 is a key mediator in TGF-β1-induced pathogenesis of OSF. EGCG may be useful in the prevention or treatment of OSF.