Comparison of Efficacy of Pentoxifyllin with Standard Regimens Dexamethasone and Hyaluronidase in Patients with Oral Submucous Fibrosis

Aims and objectives The purpose of the study was to clinically evaluate the efficacy of oral pentoxifylline 400mg tablets in comparison to intra-lesional injections of dexamethasone (4 mg/ml), hyaluronidase 1, 500 IU and 0.5 ml of lignocaine 2% and a combination of the two in the management of oral sub-mucous fibrosis (OSF) patients. Materials and methods The study population consisted of randomly selected 75 patients with OSF. Patients were divided into three groups. A total of 25 patients were allocated each in dexamethasone group, dexamethasone and pentoxifylline group and pentoxifylline group. Dexamethasone group received weekly intra-lesional injections of dexamethasone (4 mg/ml), hyaluronidase 1, 500 IU and 0.5 ml of lignocaine 2% for a period of 12 weeks. Pentoxifylline group received oral pentoxifylline 400-mg tablets thrice daily for 12 weeks. Dexamethasone and pentoxifylline group received both the drugs. Parameters taken in the study were burning sensation and mouth opening. Results In the present study, improvement in the patients symptomatic parameters were statistically significant (p < 0.001) within groups (intra-group comparison), but not significant (p > 0.001) when compared between the groups (inter-group comparison). Conclusion Study found that the parameters like burning sensation and mouth opening showed statistically significant improvement for all the drug groups. The drug pentoxifylline showed similar improvement in the clinical parameters as that of dexona. For this reason, pentoxifylline can be indicated as a good alternative treatment for OSF in patients in whom dexamethasone is contraindicated, or those who cannot make frequent visits for intra-lesional injections.

Qualitative and quantitative analysis of palmar dermatoglyphics among smokeless tobacco users.

Context: Palm prints formed once does not change throughout life and is not influenced by environment. Palmar Dermatoglyphics can indicate the development of potentially malignant and malignant lesions and help in identifying persons at high risk of developing Oral submucous fibrosis (OSMF) and Oral squamous cell carcinoma (OSSC). Aim: To analyze the qualitative [finger ridge pattern and presence or absence of hypothenar pattern] and quantitative [mean ATD angle and total AB ridge count] variations in Palmar Dermatoglyphics in patients suffering from OSMF and OSCC. Settings and Design: A prospective comparative study among 40 patients (Group I-10 samples of smokeless tobacco users with OSMF, Group II- 10 samples of smokeless tobacco users with OSCC, GroupIII- 10 samples of smokeless tobacco users without OSMF or OSCC and GroupIV- 10 samples without smokeless tobacco habit without OSMF and OSCC as controls) were selected. Materials and Methods: The palm prints were recorded using an HP inkjet scanner. The patients were asked to place the palm gently on the scanner with the fingers wide apart from each other. The images of the palm prints were edited and qualitative and quantitative analysis were done. Statistical Analysis Used: Statistical analysis such as Kruskal Wallis, Post Hoc and Analysis of Varience were done. Results: A highly significant difference among the finger ridge, hypothenar pattern and mean ATD angle (P<0.001) and total AB ridge count (P=0.005) in OSMF and OSCC patients were obtained. There is predominance of arches and loops, presence of hypothenar pattern, decrease in mean ATD angle and total AB ridge count in OSMF and Oral Cancer patients. Conclusion: Palmar Dermatoglyphics can predict the probable occurrence of OSMF and OSCC in smokelees tobacco users.

Clinical evaluation of the role of tulsi and turmeric in the management of oral submucous fibrosis: A pilot, prospective observational study.

The aim of the present study was to investigate the clinical efficacy of herbal medicines (1 gm tulsi and 1 gm turmeric mixed in glycerine base) for the treatment of oral submucous fibrosis (OSMF). Forty‑one patients in the age group of 17- 56 years without any systemic complications were included in the study. The patients were treated with medicines, which were to be applied 3-4 times a day. Blood samples were collected before and after treatment to screen for any systemic changes due to these medications. Burning sensation and mouth opening were recorded before and after treatment. Patients were followed up on monthly subsequent visits for three months. Changes in the burning sensation on visual analogue scale (VAS) scale and difference in the mouth opening were analyzed statistically. A statistically significant improvement was seen in both burning sensation and mouth opening. Tulsi and turmeric offers a safe and efficacious combination of natural products available for symptomatic treatment of OSMF.

Evaluation of Haemoglobin and Iron Levels in Serum of Patients with Oral Sub Mucous Fibrosis: A Clinical Study.

Background: Oral sub mucous fibrosis (OSMF) is a chronic, insidious oral mucosal condition affecting the most parts of the oral cavity with high malignant transformation rate triggered by areca nut chewing, nutritional deficiencies, immunologic processes, and genetic predisposition. OSMF causes significant haematological abnormalities resulting in change in levels of various elements. Aim and Objectives: The aim of this study was to estimate the haemoglobin and iron levels in serum among patients with oral sub mucous fibrosis and to compare the values with healthy subjects. Materials and Methods: In this clinical study 50 patients who were diagnosed histopathologically with OSMF and 50 healthy individuals will be included, and the values of haemoglobin levels will be estimated using Sahli's serum iron by Ferrene methods. Results: OSMF patients showed significantly lower levels of haemoglobin and serum iron when compared with the healthy subjects. Conclusion: The present study shows the serum iron assessment for patients with oral sub mucous fibrosis. Determining iron status is a part of biochemical assessment, which may be of proactive intervention for high-risk groups. It is suggested that the biochemical assessment of oral precancerous conditions may help in early diagnosis and prognosis. It is also of key importance that iron therapy should be instituted parallel with the initial diagnosis along with a proper balanced diet, as a part of the overall treatment of oral sub mucous fibrosis with other modes of treatment. This helps to stop the further progression of the condition.

Medical treatment modalities of oral sub mucous fibrosis.

Background: The incidence of Oral sub mucous fibrosis disease has been found to about 13% of the general population, varying from 0 to 4% depending on the geographic location, On epidemiological survey shows this disease was found in India especially in southern states with prevalence of 0.36% Ernakulum in Kerala, 0.4% in Srikakulam district in Andra Pradesh, 0.16% in Bhavnagar in Gujarat, 007% in Bihar and 0.03% in Maharashtra. The prime causes suspected are prolonged use of chilly (capsicum), betel nut, tobacco, alcohol, Pan-masala and Pan which are considered to be local factors. This study is one of the pioneer studies in the treatment of oral sub mucous fibrosis. Aim: The purpose of this study to assess the efficacy of the medical treatment modalities of oral sub mucous fibrosis and to evaluate the visceral organ involvement mainly cardiac in oral sub mucous fibrosis. Material and Method: The study consisted of 40 patients suffering from oral sub mucous fibrosis of various grades who were selected from outpatient department of oral medicine and radiology, Tamilnadu government dental college. On first visit of the patient, the selected patients were clinically divided in to various grades based on the clinical grading by Gupta et al. Result: Study was observed, statically proved and that combined therapy employing nutritional and iron supplement with intralesional injection therapy using Hyaluronidase, Dexamethasone, and Placentrex and topical application of Triamcinolone Acetonide 0.1% caused a marked improvement in the patient. Conclusion: patients signs and symptoms evidenced by increase the mouth opening, increase in tongue protrusion, improvement in the patient colour of mucosa.

Oral submucous fibrosis as a precursor of malignancy - a case report

Oral submucous fibrosis (OSF) is a high risk precancerous condition predominantly occurs in Indians and other population of the Indian subcontinent with certain oral habits. Betel quid (BQ) chewing is a popular oral habit with potential links to the occurrence of oral cancer. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. Since the ingredients of BQ, tobacco are crucial for tumour initiation, promotion and progression, exposure to these toxicants simultaneously has been shown to markedly potentiate the oral cancer incidence in OSF patients. The rate of malignant transformation of OSF has been estimated to be 4.5%. Most cases with malignant transformation in OSF had occurred gradually over a long period of time.

A Simplified Approach For Rehabilitation of An Edentulous Patient With Oral Submucous Fibrosis - A Clinical Report.

Oral sub mucous fibrosis is an insidious chronic disease and a precancerous condition, affecting any part of the oral cavity and sometimes the pharynx. Management of patient with oral sub mucous fibrosis presents difficulties at all stages, from the preliminary impressions to fabrication of prostheses. This article will present simplified approach for management of a 61year old male edentulous patient with oral sub mucous fibrosis. So that final outcome may be achieved.