What are the other Names for this Condition? (Also known as/Synonyms)

• OSMF (Oral Submucous Fibrosis)

What is Oral Submucous Fibrosis? (Definition/Background Information)

• Oral Submucous Fibrosis (OSMF) is a chronic and progressive condition of the mouth caused by chewing areca nut (seed of the areca palm) in betel quid (paan), a practice that is commonly observed in India and Southeast Asia
• The condition is localized to the oral cavity and causes ulcers, burning sensation while eating spicy foods, loss of taste sensation, and fibrosis formation in the later stages leading to difficulty in opening one’s mouth completely
• There are no well-specified treatments available for Oral Submucous Fibrosis. However, the progression of the condition can be stopped by immediately ceasing the habit of betel quid chewing. This can help lower the risk for mouth cancer development

Who gets Oral Submucous Fibrosis? (Age and Sex Distribution)

• Oral Submucous Fibrosis mostly affects individuals in the 20-40 years age range. However, it may develop outside this age range, even in adolescent children and older adults who chew betel quid
• Both males and females may be affected
• The condition is predominantly observed in India, Southeast Asia, and some parts of western Pacific region. It is rare in other parts of the world, and not generally observed anywhere elsewhere

What are the Risk Factors for Oral Submucous Fibrosis? (Predisposing Factors)

• Chewing areca nut (paan chewing) is the primary risk factor for Oral Submucous Fibrosis. The condition is reported in individuals with this habit

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Oral Submucous Fibrosis? (Etiology)

The exact cause of development of Oral Submucous Fibrosis is not well-understood.

• The condition is strongly associated with chewing areca nut that is present in betel quid (called paan or gutkha), a habit common among certain Asian cultures
• The duration of chewing betel quid prior to first appearance of symptoms may vary from a few months to several years

What are the Signs and Symptoms of Oral Submucous Fibrosis?

The signs and symptoms of Oral Submucous Fibrosis may include:

• Pain and burning sensation in the oral cavity, particularly while eating hot-spicy foods
• Dryness of mouth
• Presence of ulcer sores or blisters
• The affected region in the mouth may be focal or diffuse
• In the later stages, fibrosis (scarring) may be seen along-with:
  • Firm and rubbery cheeks (one may be unable to blow out air)
  • Puffy lips
  • White and smooth tongue with limited movement capability
  • Difficulty in opening one’s mouth to the maximum extent possible; reduced opening of jaws (trismus)
  • Eating, swallowing, and speaking difficulties
  • Loss of taste
• Poor oral hygiene and bad breath
• Gradually, involvement of the soft palate, throat, and food-pipe may be noted

How is Oral Submucous Fibrosis Diagnosed?

Oral Submucous Fibrosis is diagnosed on the basis of the following information:

• A thorough physical examination and a complete personal medical history, including a history of betel quid chewing
• Oral examination
• Laboratory tests, as necessary
• Barium swallow studies
• Tissue biopsy: A tissue biopsy of the lesion is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A tissue biopsy is often necessary to establish a diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Oral Submucous Fibrosis?

The complications of Oral Submucous Fibrosis may include:

• Difficulty in opening the mouth
• Decay of teeth
• Inability to taste food
• Hearing impairment
• Decreased quality of life
• Increased risk of developing oral squamous cell cancer - the risk is about 20%

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Oral Submucous Fibrosis Treated?

Currently, there is no effective treatment for Oral Submucous Fibrosis.

• An immediate cessation of the practice of chewing betel quid can help in stopping progression of the condition
• Frequent oral examinations are recommended to watch for any oral cancer development
• Corticosteroid injections may be regularly administered to the region of fibrosis
• For advanced stages, when opening the mouth becomes very difficult, surgery may be considered

Regular medical screening at periodic intervals with tests and physical examinations are recommended.

How can Oral Submucous Fibrosis be Prevented?

Oral Submucous Fibrosis is a condition that can be completely prevented by avoiding chewing betel quid (paan or gutkha) containing areca nut.

What is the Prognosis of Oral Submucous Fibrosis? (Outcomes/Resolutions)

• The prognosis of Oral Submucous Fibrosis is dependent upon the severity of the signs and symptoms and associated complications, if any
• An immediate stoppage of chewing betel quid may arrest progression of the condition, although it is not known to improve the scarred (fibrotic) regions of the mouth
• The risk for oral cancer development is high (about 20%) in populations with the habit of betel quid chewing

Additional and Relevant Useful Information for Oral Submucous Fibrosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/