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Clinical Examination of Oral Submucous Fibrosis

By Saurabh Sharma

Defination
Submucous fibrosis is a chronic mucosal condition affecting any part of the oral mucosa, characterized by mucosal rigidity of varying intensity due to fibroelastic transformation of the juxtaepithelial connective tissue layer

History
In 1952, J.Schwartz described five Indian women from Kenya with a condition of the oral mucosa including the palate and pillars of the fauces, which he called "atrophia idiopathica (tropica) mucosae oris S.G. Joshi subsequently coined the termed oral submucous fibrosis (OSF) for the condition in 1953.

Epidemiology
OSMF is a fibrotic disorder seen commonly in India and Indian subcontinent. Sporadic cases are seen in Malaysia, Nepal, Thailand and South Vietnam. Incidence of OSMF in India is 2-5 % of population. Persons between 20 and 40 years of age are most commonly affected ,but ages have ranged from 2 to 89 years of age

Etiology

Exact etiology is unknown. The suggested factors are 1. Chronic Irritation Areca Nut Chilies Lime Betel nut Tobacco Chewing 2. Deficiency disease. 3. Defective iron metabolism 4. Bacterial Infection 5. Collagen disorder 6. Immunological disorders 7. Genetic disorder. 8. Alcohol

Prodromal Symptoms
The most common initial symptoms are: Burning sensation on eating spicy food Blisters on the palate Ulceration or recurrent stomatitis Excessive salivation

Defective gustatory sensation


Dryness of mouth.

Difficulty in opening mouth

Inability to whistle, blow


Difficulty in swallowing When fibrosis involves pharynx- referred pain to the ear. Changes in tone of the voice due to vocal cord involvement Some times deafness due to occlusion of eustachian

tubes

Sites :- Buccal Mucosa, Palate, Retro Molar area, Lips,Tongue, Uvula,Gums Clinically discernible blanching and pallor

Signs

Palpable bands and restriction-of mouth


opening

Normal Anatomy

Blanching

Buccal Mucosa

Palate

Tongue

Gums

Uvula

Floor Of the Mouth

Lips

Oral submucous fibrosis is clinically divided into 3 stages (Pindborg J.J.)


Stage 1: Stomatitis Stage 2: Fibrosis a- Early lesions, blanching of the oral mucosa b- Older lesions, vertical and circular palpable fibrous bands in and around the mouth or lips, resulting in a mottled, marble-like appearance of the buccal mucosa Stage 3: Sequelae of oral submucous fibrosis a- Leukoplakia b- Speech and hearing deficits

Khanna and Andrade in 1995


Group I: Earliest stage without mouth opening limitations with an interincisal distance of greater than 35 mm. Group II: Patients with an interincisal distance of 26-35 mm.

Group III: Moderately advanced cases


with an interincisal distance of 15-26

mm. Fibrotic bands are visible at the


soft palate, and pterygomandibular raphe and anterior pillars of fauces are

present.

Group IVA: Trismus is severe, with an interincisal distance of less than 15 mm and extensive fibrosis of all the oral mucosa.

Group IVB: Disease is most advanced, with premalignant and malignant changes throughout the mucosa.

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