A frequent mucosal lesion in my dental practice

Posted by Sudarshan Ramachandran on Tue, Apr 15, 2014  
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I have encountered several oral mucosal diseases in dental practice. One which I diagnosis more commonly is Oral Submucous Fibrosis. It is abbreviated shortly as OSMF. It is considered as the disease likely to become malignancy or a premalignant disorder. It is caused by gutkha, areca or pan.

Pan, gutkha and areca chewing are common in India. It is practiced by younger age group men. Patients may chew because of following reasons:

1. Easily available in roadside shops

2. Available as small packets so easy to carry

3. Cheaper

4. Patients feel it as stress reliever

5. Can be chewed for long time

6. Learnt from friends

Many brands are available in combination with tobacco. These substances will be either swallowed or spit. Severity worsens if patients swallow because entire mucosa in contact with this substance gets affected.

This condition can be categorized into 3 phases:

Phase 1: A patient with chronic use fells certain changes in the oral cavity. Such features include burning mouth, tightness of the oral cavity with difficult mouth opening. Oral mucosa become white in color, on placing finger it will be tight, difficult to retract. Cheek appears wasted. Teeth can give a better clue to the oral habits of the patient. Teeth will manifest with heavy brownish stains. Patients frequently approach the dentist to get his teeth cleaned.

Phase 2: After phase 1 patient will have difficulty in consuming food. Early cases have difficulty in consuming spicy food, but later stages burning sensation occur for the normal diet. Sometimes patient may complain of difficulty in swallowing food.

Phase 3: Period of anemia that further worsens the disease.

Management options are available for treating OSMF.

1. Counsel to quit the habit: Before initiating the management the patient has to quit the chewing habit to stop the progression of this disease. Patient should be made aware of the irreversible nature of the disease and its progression to cancer. Disease management is the partial success on quitting the habit. It is the responsibility of every dentist to make the note of all other deleterious habits and make a proper discussion and counseling quit the habit.

2. Management should concentrate on the suppressing the progression of the disease to cancer. Antioxidants are most commonly tried management. Many other formulations with antioxidant properties are available nowadays. Other distressing features to be managed include burning sensation, difficulty mouth opening and sometimes ulcers. Ulcers can be managed by topical anesthetics.

3. Burning sensation: Consumption of spice less food with topical anesthetics. Severe cases may require topical steroids (triamcinolone).

4. Limited mouth opening: mouth exercises like opening and closing mouth, puffing cheek frequently to increase elasticity. Many allopathic and ayurvedic medicines have been tried to improve mouth opening and to decrease burning mouth. Gold standard drug tried by every oral physician is corticosteroids. Corticosteroids in the form of topical, systemic and intralesional have been used frequently. Intralesional method with only steroids or combinations has been tried. Severe cases may require surgical approach to increasing mouth opening.

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